Evaluation of the Specificity of Morphological Electrocardiographic Criteria for the Differential Diagnosis of Wide QRS Complex Tachycardia in Patients With Intraventricular Conduction Defects

Abstract

Most of the previously described morphological criteria favoring ventricular tachycardia are present in a substantial percentage of patients with IVCD during sinus rhythm. These findings suggest a limited applicability of these criteria in this subset of patients.

Current Algorithms for the Diagnosis of wide QRS Complex Tachycardias

“…Grimm et al [42] compared the diagnostic value of the classical criteria published by Wellens in 1978 and the Brugada algorithm analyzing 240 WCTs, and found a sensitivity for VT diagnosis >90% for both criteria and a specificity of 70% and 72% for RBBB-like and 87% each for LBBB-like WCTs and found that the combined use of both criteria did not increase the sensitivity and specificity. Alberca et al [43] demonstrated that the presence of pre-existing BBB and the use of class I antiarrhythmic drugs or amiodarone result in a low specificity (63%) of the 2 nd Brugada criterion (i.e. in many of these patients with WCT due to SVT the longest RS interval in the precordial leads will be >100 ms suggesting a misdiagnosis of VT).…”

Wie nützlich sind die Algorithmen zur Differentialdiagnostik der monomorphen Tachykardien mit breitem QRS-Komplex in kardiologischen Notfällen?

“…Fehlen eines RS-Komplexes (Abbildung 4) in allen Brustwandableitungen; 2. Die zwei neuen Kriterien zusammen hatten eine Spezifität von nur 57% [7]. Auf dieser Basis wurde ein Algorithmus erarbeitet.…”

“…Das Kriterium wurde nur bei insgesamt sechs von 333 Patienten mit SVT registriert [1,7,14]. Das Kriterium wurde nur bei insgesamt sechs von 333 Patienten mit SVT registriert [1,7,14].…”

“…Nur fünf von zwölf untersuchten EKG-Kriterien hatten eine Spezifität von > 90% [7]. Einige davon haben eine gute Spezifität, jedoch eine schlechte Sensitivität.…”

Blood oxygen saturation during atrio-ventricular dissociation with wide-QRS complex tachycardias

“…However, the 12-lead electrocardiogram still has limitations in diagnosing the mechanism of WQRSCT. Possible examples are pre-existing conduction defects [9], existence of specific VT forms such as left fascicular VT and bundle branch re-entrant VT that are often indistinguishable from SVT using surface ECG analysis. Atrio-ventricular dissociation including various forms of ventriculoatrial block is a hallmark of VT [10][11][12][13], but its presence or absence is often unclear from the surface ECG analysis.…”